Cervical Spine Computed Tomography Imaging Artifact Affecting Clinical Decision-Making in the Traumatized Patient

Abstract

CT scanning is an important tool in the evaluation of trauma patients. We review a case involving a trauma patient in which a cervical spine computed tomography (CT) artifact affected decision-making by physicians. The CT artifact mimicked bilateral dislocated facets (51-B1.1). On the basis of CT findings, the patient was transferred to a different hospital for evaluation. Discrepancy between the primary CT scan and patient physical exam prompted secondary CT scans and X-ray evaluation; neither of these studies showed osseous abnormalities. This case reinforces the necessity for physicians to formulate their diagnosis based upon multiple areas of information including physical examination, plain x-ray and subsequent advanced imaging, rather than relying solely on advanced imaging.

ACR Appropriateness Criteria® Suspected Spine Trauma

“…Flexion-extension views are often inadequate for assessing cervical instability because of either limited excursion of the cervical spine or poor visualization of the cervicothoracic junction, and they rarely demonstrate cervical instability not identified on conventional cervical radiographs [32][33][34][35]. A single upright lateral cervical spine radiograph may be useful as a problem-solving tool in case of motion on cervical spine CT. Normal radiographic findings in the area of patient motion may obviate repeat CT [36].…”

Magnetic Resonance Imaging in Cervical Spine Trauma: More Than Soft Tissue Illustration

“…Upper cervical injuries consist of a diverse group of injuries that affect the skull base, atlas, and axis and often result from high-energy injuries like sudden moves of the spine and strong blows to the head [1].…”

“…CT is increasingly indicated as the sole primary screening tool in high-energy injuries, almost eliminating the need for traditional radiographs to clarify bony cervical spine injuries [1]. A mismatch is considered in cases when there is a high level of clinical suspicion for a spinal fracture, whereas CT images fail to provide direct evidence of a bone fracture.…”

“…Computed tomography (CT) has become the first choice as a routine screening tool in the emergency department with a reported sensitivity as high as 98%, offering a clear advantage over other diagnostic tools in terms of the speed and convenience of the assessment. CT rarely misses spinal fractures [1]. On the other hand, magnetic resonance imaging (MRI) is the appropriate examination tool to explain the patient's neurological status.…”

Missed cervical spine subluxation leading to bilateral facet dislocation with severe deformity requiring 360 fixation

“…Diagnostic errors are predictable events with readily identifiable contributing factors [18] . The value proposition here is to incorporate a systemic methodology for interpreting cervical spine CT's in a similar way to cervical spine radiography to reduce the interobserver bias [22] , [23] .…”